SHM Converge Scientific Abstract ePoster Gallery-Mass Effect: The Role of Cognitive Bias in a 'Near-Miss' Diagnosis

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This case describes a 68-year-old Spanish-speaking woman with diabetes and heavy tobacco use who presented with acute chest pain, nausea, vomiting, and bilateral arm numbness. Initial testing showed elevated high-sensitivity troponin and nonspecific ECG changes. Chest imaging unexpectedly revealed a new right upper lobe lung mass invading the chest wall and rib. Because the lung mass seemed like a plausible explanation, cardiology assessed the troponin rise as non-ischemic or possibly due to type 2 MI, and no further cardiac intervention was recommended.<br /><br />However, the patient had classic ischemic symptoms, a significant troponin rise, and evolving ECG changes. She was not initially treated for type 1 MI. After a period of symptom improvement and a plan for outpatient biopsy, her chest pain recurred, and she developed an inferior STEMI. Cardiac catheterization then showed subtotal thrombotic occlusion of the mid right coronary artery, requiring PCI with two drug-eluting stents.<br /><br />The presentation highlights how cognitive bias, especially anchoring and availability bias, can delay recognition of myocardial infarction when another serious diagnosis is present. It also emphasizes social and clinical disparities: women, and particularly Hispanic women, are more likely to have missed or undertreated MI and higher mortality after acute coronary syndromes.<br /><br />The authors conclude that clinicians should remain alert to implicit bias and use standardized clinical pathways and guideline-based tools to reduce diagnostic error, especially in high-risk populations with chest pain.

Asset Subtitle

Beth Smilkstein

Meta Tag

Author List Beth Smilkstein, Kasey Bowden

Category Clinical Vignettes

Concept Myocardial Ischemia

Concept Type 1 Myocardial Infarction

Concept Chest Pain

Concept Diagnosis delay

Concept Missed Diagnosis

Distinguished Non-Finalist

Presenter Organization University of Colorado School of Medicine

Presenting Author Beth Smilkstein

Track Adult

Keywords

myocardial infarction

type 1 MI

inferior STEMI

troponin elevation

right coronary artery

percutaneous coronary intervention

cognitive bias

anchoring bias

availability bias

health disparities

Myocardial Ischemia

Type 1 Myocardial Infarction

Chest Pain

Diagnosis delay

Missed Diagnosis